Purpose: To identify factors associated with adjacent-level ossification development (ALOD) after anterior cervical discectomy and fusion (ACDF) and associated clinical outcomes. Methods: We retrospectively reviewed records of 140 adults who underwent primary ACDF for degenerative disc disease. We compared patients with and without ALOD after ACDF. Radiographic measurements and factors associated with ALOD were assessed preoperatively and at minimum 24-month follow-up. Clinical outcomes were incidence of clinical adjacent-segment pathologies (CASP), revision surgery, and patient-reported outcomes. Results: Factors associated with both cranial and caudal ALOD were short plate-to-disc distance (PDD), adjacent-segment kyphosis, hyperlordotic ACDF causing junctional segment kyphosis, and preoperative ossification of the anterior longitudinal ligament (OALL). Mean final adjacent-segment range of motion (ROM) was less in those with cranial ALOD (6.9° ± 2.8°) than in those without cranial ALOD (12° ± 4.2°) (p < 0.01). Mean final adjacent-segment ROM was also less in those with caudal ALOD (5.5° ± 2.4º) than in those without caudal ALOD (8.2º ± 3.7º) (p < 0.01). The incidence of CASP-required surgery was higher in those with caudal ALOD (p = 0.02) but no different in those with cranial ALOD (p = 0.69) compared with those without ALOD. Conclusion Factors associated with ALOD were a kyphotic segment adjacent to ACDF, hyperlordotic fusion, preoperative OALL, and short PDD. ALOD was associated with less segmental ROM and, for those with caudal but not cranial ALOD, higher incidence of revision surgery for CASP.

Purpose: To identify factors associated with adjacent-level ossification development (ALOD) after anterior cervical discectomy and fusion (ACDF) and associated clinical outcomes. Methods: We retrospectively reviewed records of 140 adults who underwent primary ACDF for degenerative disc disease. We compared patients with and without ALOD after ACDF. Radiographic measurements and factors associated with ALOD were assessed preoperatively and at minimum 24-month follow-up. Clinical outcomes were incidence of clinical adjacent-segment pathologies (CASP), revision surgery, and patient-reported outcomes. Results: Factors associated with both cranial and caudal ALOD were short plate-to-disc distance (PDD), adjacent-segment kyphosis, hyperlordotic ACDF causing junctional segment kyphosis, and preoperative ossification of the anterior longitudinal ligament (OALL). Mean final adjacent-segment range of motion (ROM) was less in those with cranial ALOD (6.9° ± 2.8°) than in those without cranial ALOD (12° ± 4.2°) (p < 0.01). Mean final adjacent-segment ROM was also less in those with caudal ALOD (5.5° ± 2.4º) than in those without caudal ALOD (8.2º ± 3.7º) (p < 0.01). The incidence of CASP-required surgery was higher in those with caudal ALOD (p = 0.02) but no different in those with cranial ALOD (p = 0.69) compared with those without ALOD. Conclusion Factors associated with ALOD were a kyphotic segment adjacent to ACDF, hyperlordotic fusion, preoperative OALL, and short PDD. ALOD was associated with less segmental ROM and, for those with caudal but not cranial ALOD, higher incidence of revision surgery for CASP.

Purpose: To identify factors associated with adjacent-level ossification development (ALOD) after anterior cervical discectomy and fusion (ACDF) and associated clinical outcomes. Methods: We retrospectively reviewed records of 140 adults who underwent primary ACDF for degenerative disc disease. We compared patients with and without ALOD after ACDF. Radiographic measurements and factors associated with ALOD were assessed preoperatively and at minimum 24-month follow-up. Clinical outcomes were incidence of clinical adjacent-segment pathologies (CASP), revision surgery, and patient-reported outcomes. Results: Factors associated with both cranial and caudal ALOD were short plate-to-disc distance (PDD), adjacent-segment kyphosis, hyperlordotic ACDF causing junctional segment kyphosis, and preoperative ossification of the anterior longitudinal ligament (OALL). Mean final adjacent-segment range of motion (ROM) was less in those with cranial ALOD (6.9° ± 2.8°) than in those without cranial ALOD (12° ± 4.2°) (p < 0.01). Mean final adjacent-segment ROM was also less in those with caudal ALOD (5.5° ± 2.4º) than in those without caudal ALOD (8.2º ± 3.7º) (p < 0.01). The incidence of CASP-required surgery was higher in those with caudal ALOD (p = 0.02) but no different in those with cranial ALOD (p = 0.69) compared with those without ALOD. Conclusion Factors associated with ALOD were a kyphotic segment adjacent to ACDF, hyperlordotic fusion, preoperative OALL, and short PDD. ALOD was associated with less segmental ROM and, for those with caudal but not cranial ALOD, higher incidence of revision surgery for CASP.

Purpose: To identify factors associated with adjacent-level ossification development (ALOD) after anterior cervical discectomy and fusion (ACDF) and associated clinical outcomes. Methods: We retrospectively reviewed records of 140 adults who underwent primary ACDF for degenerative disc disease. We compared patients with and without ALOD after ACDF. Radiographic measurements and factors associated with ALOD were assessed preoperatively and at minimum 24-month follow-up. Clinical outcomes were incidence of clinical adjacent-segment pathologies (CASP), revision surgery, and patient-reported outcomes. Results: Factors associated with both cranial and caudal ALOD were short plate-to-disc distance (PDD), adjacent-segment kyphosis, hyperlordotic ACDF causing junctional segment kyphosis, and preoperative ossification of the anterior longitudinal ligament (OALL). Mean final adjacent-segment range of motion (ROM) was less in those with cranial ALOD (6.9° ± 2.8°) than in those without cranial ALOD (12° ± 4.2°) (p < 0.01). Mean final adjacent-segment ROM was also less in those with caudal ALOD (5.5° ± 2.4º) than in those without caudal ALOD (8.2º ± 3.7º) (p < 0.01). The incidence of CASP-required surgery was higher in those with caudal ALOD (p = 0.02) but no different in those with cranial ALOD (p = 0.69) compared with those without ALOD. Conclusion Factors associated with ALOD were a kyphotic segment adjacent to ACDF, hyperlordotic fusion, preoperative OALL, and short PDD. ALOD was associated with less segmental ROM and, for those with caudal but not cranial ALOD, higher incidence of revision surgery for CASP.

Purpose: To identify factors associated with adjacent-level ossification development (ALOD) after anterior cervical discectomy and fusion (ACDF) and associated clinical outcomes. Methods: We retrospectively reviewed records of 140 adults who underwent primary ACDF for degenerative disc disease. We compared patients with and without ALOD after ACDF. Radiographic measurements and factors associated with ALOD were assessed preoperatively and at minimum 24-month follow-up. Clinical outcomes were incidence of clinical adjacent-segment pathologies (CASP), revision surgery, and patient-reported outcomes. Results: Factors associated with both cranial and caudal ALOD were short plate-to-disc distance (PDD), adjacent-segment kyphosis, hyperlordotic ACDF causing junctional segment kyphosis, and preoperative ossification of the anterior longitudinal ligament (OALL). Mean final adjacent-segment range of motion (ROM) was less in those with cranial ALOD (6.9° ± 2.8°) than in those without cranial ALOD (12° ± 4.2°) (p < 0.01). Mean final adjacent-segment ROM was also less in those with caudal ALOD (5.5° ± 2.4º) than in those without caudal ALOD (8.2º ± 3.7º) (p < 0.01). The incidence of CASP-required surgery was higher in those with caudal ALOD (p = 0.02) but no different in those with cranial ALOD (p = 0.69) compared with those without ALOD. Conclusion Factors associated with ALOD were a kyphotic segment adjacent to ACDF, hyperlordotic fusion, preoperative OALL, and short PDD. ALOD was associated with less segmental ROM and, for those with caudal but not cranial ALOD, higher incidence of revision surgery for CASP.

Introduction: Orthopaedic theatre lists are an important tool which must convey essential information to all staff to run an effective and safe theatre list. However, there are no set standards or guidelines on the components of an Orthopaedic theatre list. The objective of this study is to formulate guidelines for elective Orthopaedic theatre lists which improve efficiency and reduce errors. Materials and methods: We looked at 326 elective Orthopaedic theatre lists from October to November 2018. Various factors such as: theatre and patient demographics, surgical team, type of anaesthesia, Surgery, acronyms and finally extra information such as allergies. Additionally, a survey was distributed to a variety of theatre staff to understand their requirements from a theatre list. Thereafter, we created a proforma for waiting list coordinators. Subsequently, we re-audited six more weeks of theatre lists (255) from November to December 2019. Results: The orthopaedic consultant in charge was noted for 100% of patients compared to 85% previously. There was an improvement in documenting the required anaesthesia such as noting 14.5% required spinal compared to 0.3% previously. Prosthesis/equipment was mentioned for 34% of patients compared to 23%. Fluoroscopy was noted as being required for 25% of patients compared to 11%. Conclusion: We believe standards should be in place in order for us to follow to ensure we carry out safe and efficient Orthopaedic theatre lists, and these standards should entail the parameters we have audited. The ‘William Harvey theatre list standard’ should be used as a gold standard for all elective Orthopaedic theatre lists.

Objective: Few studies have reported radiographic and clinical outcomes of transverse process hook (TPH) placement at the proximal thoracic upper instrumented vertebra (UIV) in adult spinal deformity (ASD) surgery. This study aims to investigate radiographic and clinical outcomes of TPH placement at the UIV for ASD surgery. Methods: This is a retrospective cohort of 56 patients with ASD (age, 59 ± 13 years; followup, 44 ± 19 months) from Johns Hopkins Hospital, who underwent long posterior spinal fusion to the proximal thoracic spine (T2–5). Visual analogue scale (VAS) for back pain, Oswestry Disability Index (ODI), 36-item Short Form health survey scores, thoracic kyphosis (TK), lumbar lordosis, sacral slope, pelvic tilt, pelvic incidence, proximal junctional kyphosis (PJK) angle, PJK incidence, pattern of PJK, grades of TPH dislodgement, revision surgery, and factors associated with high-grade TPH dislodgement were analyzed. Results: VAS for back pain and ODI values improved significantly from preoperatively to final follow-up. Mean change in PJK angle was 12° (range, 0.5°–43°). Twenty patients (36%) developed PJK, of whom 13 had compression fractures at 1 vertebra distal to the UIV (UIV–1). Final TPH position was stable in 42 patients (75%). In most patients (86%), TPH dislodgement did not progress after 6-month postoperative follow-up. Three patients (5.3%) underwent revision surgery to extend the fusion because of symptomatic PJK. Unstable TPH position was associated only with revision surgery and TK. Conclusion TPH placement at the proximal thoracic UIV for long fusion showed favorable clinical and radiographic outcomes in terms of the incidence of PJK and mean PJK angle at mean 44-month follow-up. TPHs placed in the proximal thoracic UIV were in stable position in 75% of patients. Compression fracture at UIV–1 was the most common pattern of PJK. PJK angle progression was greater in revision cases and in patients with greater preoperative thoracic kyphosis.

Objective: Few studies have reported radiographic and clinical outcomes of transverse process hook (TPH) placement at the proximal thoracic upper instrumented vertebra (UIV) in adult spinal deformity (ASD) surgery. This study aims to investigate radiographic and clinical outcomes of TPH placement at the UIV for ASD surgery. Methods: This is a retrospective cohort of 56 patients with ASD (age, 59 ± 13 years; followup, 44 ± 19 months) from Johns Hopkins Hospital, who underwent long posterior spinal fusion to the proximal thoracic spine (T2–5). Visual analogue scale (VAS) for back pain, Oswestry Disability Index (ODI), 36-item Short Form health survey scores, thoracic kyphosis (TK), lumbar lordosis, sacral slope, pelvic tilt, pelvic incidence, proximal junctional kyphosis (PJK) angle, PJK incidence, pattern of PJK, grades of TPH dislodgement, revision surgery, and factors associated with high-grade TPH dislodgement were analyzed. Results: VAS for back pain and ODI values improved significantly from preoperatively to final follow-up. Mean change in PJK angle was 12° (range, 0.5°–43°). Twenty patients (36%) developed PJK, of whom 13 had compression fractures at 1 vertebra distal to the UIV (UIV–1). Final TPH position was stable in 42 patients (75%). In most patients (86%), TPH dislodgement did not progress after 6-month postoperative follow-up. Three patients (5.3%) underwent revision surgery to extend the fusion because of symptomatic PJK. Unstable TPH position was associated only with revision surgery and TK. Conclusion TPH placement at the proximal thoracic UIV for long fusion showed favorable clinical and radiographic outcomes in terms of the incidence of PJK and mean PJK angle at mean 44-month follow-up. TPHs placed in the proximal thoracic UIV were in stable position in 75% of patients. Compression fracture at UIV–1 was the most common pattern of PJK. PJK angle progression was greater in revision cases and in patients with greater preoperative thoracic kyphosis.

Objective: Few studies have reported radiographic and clinical outcomes of transverse process hook (TPH) placement at the proximal thoracic upper instrumented vertebra (UIV) in adult spinal deformity (ASD) surgery. This study aims to investigate radiographic and clinical outcomes of TPH placement at the UIV for ASD surgery. Methods: This is a retrospective cohort of 56 patients with ASD (age, 59 ± 13 years; followup, 44 ± 19 months) from Johns Hopkins Hospital, who underwent long posterior spinal fusion to the proximal thoracic spine (T2–5). Visual analogue scale (VAS) for back pain, Oswestry Disability Index (ODI), 36-item Short Form health survey scores, thoracic kyphosis (TK), lumbar lordosis, sacral slope, pelvic tilt, pelvic incidence, proximal junctional kyphosis (PJK) angle, PJK incidence, pattern of PJK, grades of TPH dislodgement, revision surgery, and factors associated with high-grade TPH dislodgement were analyzed. Results: VAS for back pain and ODI values improved significantly from preoperatively to final follow-up. Mean change in PJK angle was 12° (range, 0.5°–43°). Twenty patients (36%) developed PJK, of whom 13 had compression fractures at 1 vertebra distal to the UIV (UIV–1). Final TPH position was stable in 42 patients (75%). In most patients (86%), TPH dislodgement did not progress after 6-month postoperative follow-up. Three patients (5.3%) underwent revision surgery to extend the fusion because of symptomatic PJK. Unstable TPH position was associated only with revision surgery and TK. Conclusion TPH placement at the proximal thoracic UIV for long fusion showed favorable clinical and radiographic outcomes in terms of the incidence of PJK and mean PJK angle at mean 44-month follow-up. TPHs placed in the proximal thoracic UIV were in stable position in 75% of patients. Compression fracture at UIV–1 was the most common pattern of PJK. PJK angle progression was greater in revision cases and in patients with greater preoperative thoracic kyphosis.

Objective: Few studies have reported radiographic and clinical outcomes of transverse process hook (TPH) placement at the proximal thoracic upper instrumented vertebra (UIV) in adult spinal deformity (ASD) surgery. This study aims to investigate radiographic and clinical outcomes of TPH placement at the UIV for ASD surgery. Methods: This is a retrospective cohort of 56 patients with ASD (age, 59 ± 13 years; followup, 44 ± 19 months) from Johns Hopkins Hospital, who underwent long posterior spinal fusion to the proximal thoracic spine (T2–5). Visual analogue scale (VAS) for back pain, Oswestry Disability Index (ODI), 36-item Short Form health survey scores, thoracic kyphosis (TK), lumbar lordosis, sacral slope, pelvic tilt, pelvic incidence, proximal junctional kyphosis (PJK) angle, PJK incidence, pattern of PJK, grades of TPH dislodgement, revision surgery, and factors associated with high-grade TPH dislodgement were analyzed. Results: VAS for back pain and ODI values improved significantly from preoperatively to final follow-up. Mean change in PJK angle was 12° (range, 0.5°–43°). Twenty patients (36%) developed PJK, of whom 13 had compression fractures at 1 vertebra distal to the UIV (UIV–1). Final TPH position was stable in 42 patients (75%). In most patients (86%), TPH dislodgement did not progress after 6-month postoperative follow-up. Three patients (5.3%) underwent revision surgery to extend the fusion because of symptomatic PJK. Unstable TPH position was associated only with revision surgery and TK. Conclusion TPH placement at the proximal thoracic UIV for long fusion showed favorable clinical and radiographic outcomes in terms of the incidence of PJK and mean PJK angle at mean 44-month follow-up. TPHs placed in the proximal thoracic UIV were in stable position in 75% of patients. Compression fracture at UIV–1 was the most common pattern of PJK. PJK angle progression was greater in revision cases and in patients with greater preoperative thoracic kyphosis.